Predictive Value of Troponin I for Acute Respiratory Distress Syndrome in Children With Shock

INTRODUCTION The purpose of the present study is to establish a Troponin I (TI) in peripheral blood as a prognostic indicator in the emergence of the syndrome of acute respiratory difficulty (ARDS) in children with shock.

It should be noted that both shock and ARDS are life-threatening disease and one can trigger another (shock first then ARDS or ARDS then shock). Both involve abnormalities in blood flow (perfusion) tissues that leads to cellular stress, reduction of oxygen suplly (hypoxia), nutrients, consenquently generating an increase in tissue´s metabolic demands. This set of events is called ischemia.

The shock is a dynamic clinical syndrome of acute and complex circulatory dysfunction, caused by severe illness or trauma. To perpetuate itself generates multiple organ dysfunction and death. Regardless of its cause, it is conceptualized as a state of acute oxygen deficiency that prevents cell sustainability. The shock is one of the five leading causes of admission to emergency Pediatrics unit (EPU) of the Hospital Civil de Guadalajara "Fray Antonio Alcalde" (HCFAA).

Shock is the second cause of mortality in patients in the EPU. ARDS is an acute and diffuse, pulmonary inflammatory lesion characterized by increased pulmonary vascular permeability, weight and the decrease ventilation on the lung tissue. The specific clinical elements are hypoxemia and bilateral radiographic opacities associated with increases in the mixture of venous blood, physiological dead space and reduction of the pulmonary compliance. Diffuse alveolar damage is the morphological element that is in the acute phase (e.g. swelling, inflammation, hyaline membrane or bleeding). It has a mortality rate of 30-50% in the world.

TI is a protein that is determined in blood only under pathological conditions; mainly increases when there is myocardial ischemia. It was used in the first instance to diagnose acute coronary syndromes as ischemia, coronary angina pectoris and acute myocardial infarction.